Feeling engaged is a prime driver of physicians’ satisfaction and dissatisfaction with their jobs. When physicians feel a lack of engagement—or are outright disengaged—it manifests itself in various ways, from feelings of hopelessness, anger or cynicism to, ultimately, leaving or wanting to leave their jobs.
That’s a matter of particular concern given that turnover and prolonged vacancies are key cost drivers—estimated to run as high as $100,000 per month when all costs and lost revenue are considered.
“Administrators often see non-engaged physicians as difficult—and are frustrated by behaviors that range from passivity to selective noncompliance to active resistance,” says Liz Ferron, senior consultant for VITAL WorkLife.
“Yet without physician buy-in and active participation in new initiatives around quality, efficiency, patient satisfaction and related strategies, healthcare organizations can have little likelihood of success.”
In 2013, VITAL WorkLife conducted a nationwide, multi-specialty Physician Engagement Survey with Cejka Search to gain a better understanding of what physician engagement really means to physicians and the organizations that employ them.
The 1,666 physician respondents confirmed (with a 99% confidence level and +/- 3% margin of error against the national active physician population) that engagement is extremely important to physicians’ job satisfaction. Based on a 10-point Likert scale ranging from 1 (unimportant) to 10 (very important), the average score was 8.0, with a quarter scoring 10, and two-thirds (66.2%) scoring it in the high range. Yet, the survey showed that their actual feelings of engagement were lower, with average scores of 7.7 for engagement with their work, and just 6.4 for engagement with their organizations.
Another significant takeaway was that administrators often underestimate how large a role engagement plays in physicians’ decisions to accept a practice opportunities and/or leave a current job. When asked how important a role engagement plays in physicians’ decisions to accept a practice opportunity:
- The average score for physicians was 7.3
- The average score for administrators was 6.9
The gap in scores was even greater when asked about the role engagement played in physicians’ decisions to leave a practice:
- The average score for physicians was 6.3
- The average score for administrators was 5.4
The degree to which administrators underestimate the role that engagement plays for a physician making career decisions is troubling given the predicted shortage of physicians as boomer physicians retire.
What Does Engagement Really Mean to Physicians?
Engagement as a term is used a lot—but what does it really mean to physicians? Lacking specificity around this—and solid metrics—it’s nearly impossible for administrators to achieve an increase in engagement with their physician population. This formed the primary goal of the survey—to understand what engages physicians, and then based on this knowledge, assist healthcare organizations in making increased physician engagement actionable.
Asked to evaluate 15 elements of engagement, physicians clearly felt that all of the elements of engagement were very important to feeling engaged, based upon average scores ranging from 7.9 to 9.2 on a 10-point Likert scale. These were well above the 3.0 to 7.0 point mid-range and all were in the upper quartile.
The top five elements of engagement in absolute terms were:
- Respect for my competency and skills (9.2 average score)
- Feeling that my opinions and ideas are valued (9.1)
- Good relationships with my physician colleagues (9.1)
- Good work/life balance (9.1)
- A voice in how my time is structured and used (9.0)
The least important elements were participation in setting broader organizational goals and strategies (7.9 average score) and working for a leader in innovation and patient care (8.1), followed by alignment with the organization’s mission and goals (8.2). However, given how high these scores were, it underlines the fact that these elements are still important to physicians.
Physician respondents gave universally lower marks for how well they felt these elements were true of their current practices, with average scores ranging from 5.8 to 8.0 with a majority in the 6 range.
The gaps between what was important to feeling engaged and what was true of their current practices ranged from .9 to 2.6 points. The largest gaps were:
- Feeling that my opinions and ideas are valued (2.6 point gap)
- A voice in clinical operations and processes (2.4)
- A voice in how my time is structured and used (2.4)
- Fair compensation for my work (2.4)
- Good work/life balance (2.4)
There are sizable gaps between what is important to physicians to feel engaged and what they perceive they are experiencing in their current practice—and also with the ideal of a 10 score which, given their importance scores for all elements, is a better reflection of their true expectations.
Administrators essentially understand the degree to which specific elements are important to physicians’ feelings of engagement, but tend to overstate how well their organizations are providing what physicians want.
The cost of overestimating physician satisfaction and not doing enough to engage physicians may ultimately be reflected not just in higher physician turnover but also lower morale and sub-optimal performance operationally and clinically.
Steps for Building Engagement Initiatives
- Begin by checking the pulse on your physicians. Ask them how engaged they’re currently feeling—and what are the drivers of engagement for them. An online survey is ideal, as you are likely to get a higher level of participation if responses can be collected anonymously.
“It’s important to dig as deeply as possible into specifics,” explains Ferron. “Try to learn as much as possible about what your physicians find the most important—and where they see the gaps with their experiences.” - Share the results of your survey in forums that encourage discussion and interaction. If possible, recruit a physician to serve as a champion or thought leader who can guide the process and encourage participation.
“Nothing will speak louder about your commitment to engagement than airing the results and listening to physician reactions,” says Ferron. - Once there is clear definition, develop a roadmap of what needs to change, then communicate and act on it. Make your plan as tangible as possible, and provide tools and resources to support those who are impacted.
“As tempting as it will be to create a quid pro quo between the elements to focus on and specific organizational goals and initiatives, resist the urge,” cautions Ferron. “Pressing another agenda may be counterproductive and undermine your efforts to foster engagement.”
Best Practices
- Ensure that physicians are involved in decision-making at every step, and if possible, leading key initiatives and activities.
- Provide training to leaders on how to identify and address barriers effectively—both with physicians and senior administrators.
- Ensure that there are clear benchmarks and accountability around each initiative—everyone should know who is responsible, time frames, how progress or success will be measured.
- Measure progress periodically and adjust tactics, as needed. Communicate results honestly and constructively
Organizations with highly disengaged physicians may want to bring in outside objective outside parties to facilitate the launch of their next engagement initiatives.
“Einstein said, ‘No problem can be solved from the same level of consciousness that created it,’” says Ferron. “If you have a top-down organization that’s disengaging physicians, bringing in an unbiased third party can increase your chances of success.”
